Individual
MICHAEL HENRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PWS
Contact information
Practice address
9605 GRAND RONDE RD, GRAND RONDE, OR 97347-9712
(503) 879-2060
Mailing address
9605 GRAND RONDE RD, GRAND RONDE, OR 97347-9712
(503) 879-2060
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
THW000109397
OR
Other
Enumeration date
08/16/2023
Last updated
08/16/2023
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